Cancer referral delays increasing patient death rate

Cancer deaths in England could be reduced if GPs used the two-week urgent referral route for suspected cases more frequently, new research suggests.

A study funded by Cancer Research UK and the National Institute for Health Research has found that the death rate is higher in cancer patients whose GPs do not regularly send patients through the urgent referral route.

Looking at data from 215,284 English cancer patients, researchers from King’s College London found a clear link between the risk of death and the likelihood of their GP practice to referring cancer patients to a specialist through the two-week route.

Death rates were up 7% in those practices using the special referral route least often compared to those with normal use of the system, according to the study, findings of which have been published in the British Medical Journal.

The urgent two-week referral pathway was introduced in England in the early 2000s, but this is the first time its impact on cancer survival has been measured.

Commenting on the findings, Sara Hiom, Cancer Research UK’s director of early diagnosis, said “it’s never been clearer that reducing late diagnosis saves lives and this research adds to our understanding of what can be done about it”.

Lead study author Henrik Moller, an epidemiologist at King’s College London, said “increasing a GP’s cancer awareness and their likelihood of urgently referring cancer patients could help reduce deaths,” but he also cautioned against overuse of the pathway, “which the NHS isn’t equipped to respond to”.

Detection is improving

The Royal College of GPs has stressed that the cancer detection rate in England has increased from 42.9% in 2010 to 48.8% in 2014, and argues that “detection rates should be the benchmark used, and not the proportion of urgent referrals diagnosed with cancer”.

Looking forward, Richard Roope, Cancer Lead for the RCGPs and CR UK, says the recent publication of NICE Guidance for Suspected Cancer and the Cancer Task Force, “gives GPs the opportunity to lower the threshold for referring those with symptoms that could be caused by cancer, which will have the benefit of diagnosing more cancers at an earlier stage, with its associated better outcomes”.

"However this can only be achieved if general practice is better resourced and GPs are given greater access to diagnostic tools such as CT and MRI scans,” said. “Our access is one of the worst in Europe and better access would mean we are able to refer even more appropriately”.